Mental health care from home

The provision of mental healthcare services in Australia has been a stand-out success of our nation’s response to the COVID-19 pandemic. Since the start of the COVID-19 pandemic, we’ve seen an increased prevalence of psychological distress and commensurate rises in the use of mental healthcare services, without a rise in deaths from suicide^[1].

Telehealth services during the COVID-19 pandemic

At the outset of the COVID-19 pandemic, there were nearly 240,000 weekly mental health-related services funded by the Medicare Benefits Schedule (MBS). The most recent data show service utilisation was 20% higher in mid-2021 compared to the same time of year in 2019 (before the pandemic began), at around 300,000 per week[1]. We’ve come a long way since 2018 when the total use of telehealth for mental health consultations totalled 4141 for the entire first year (0.07% of all MBS-funded psychology consultations)^[2].

In the midst of the pandemic, 50% of Medicare-subsidised mental health service use was provided via telehealth.

Men aren’t always great at seeking help for mental health problems and can feel let down by health services that inadvertently present barriers to engagement^[3]. However, telehealth could conceivably remove some of these obstacles and enable better access for men.

Telehealth is effective for the treatment of mental illness, whether it’ is delivered via telephone or videoconferencing^[4], and is accepted by patients as an alternative to face-to-face consultations (although it might not be preferred)^[5].

A substantial amount of evidence for the efficacy of videoconferencing in treating mental illness comes from studies of males because most participants in randomised controlled trials of telehealth for mental illness are US military veterans⁵.

Men’s contribution to the evidence base for telemedicine for mental health care is not mirrored by their use of telehealth for mental health care. Prior to the COVID-19 pandemic, men were less likely than women to use telehealth consultations⁵, consistent with their use of face-to-face services^[6]. If anything, the COVID-19 pandemic has widened this gender gap. MBS-subsidised telehealth consultations for males have been less than half those of females during the COVID-19 pandemic^[7].

In addition to gender, education and socioeconomic status influence the use of telehealth services for mental health care — more educated and more advantaged people are more likely to utilise telehealth for psychological services and satisfaction is higher for younger people⁵. Some of the effects of these sociodemographic variables might be explained by access to, and familiarity with, enabling technologies. This possibility might explain older Australian men’s apparent preference for telephone consultations for mental healthcare over videoconferencing⁷.

While there’s little doubt that the expansion of mental health services via telehealth during the COVID-19 pandemic has substantially increased the provision of psychological services, there’s an opportunity to learn much more from this recent experience^[8]. The success of telehealth services during the COVID-19 pandemic has seen the government commit to continue funding of psychological therapy sessions by telehealth until at least the end of 2022^[2], and clearly demonstrates the potential benefit that might be realised from making them permanent features of our health system.

The availability of telehealth for primary care has become a permanent feature of the Australian healthcare system^[3].

As we move more towards greater use of telecommunication services for health care, we have an opportunity to learn more about what works and what doesn’t. We will need to educate health practitioners about how to best provide services via telehealth, learn how to integrate telehealth and face-to-face services, and ensure there is equitable access to the technologies necessary for everyone to benefit^[9].